Can anyone help me with the differences between a 'normal' birth and a vbac?

(9 Posts)
Tory79 Fri 02-May-14 11:44:15

Had ds at 36 weeks by elcs due to a rare complication that is unlikely to happen again this time. Surgery was fine, recovery all normal.

I am now 18weeks with no 2 and had my consultants appt this morning to discuss the birth. I say discuss.... I was rushed in and out in about 5m. As soon as I sat down he said so, you'll be looking forward to a natural birth this time, which kind of set the tone anyway. I guess because I don't have a complicated birth story to dissect and am unlikely to suffer the same complication I seemed like a rather straightforward case, which to be fair, I am, and I am inclined to go for vbac, but I just didn't really get the chance to ask anything!!

So can anyone help with the differences between a normal vaginal birth and a vbac? The only thing I managed to ask was about monitoring, and he kind of contradicted himself anyway because he said it wasn't an issue but also said yes I'd have to be monitored the whole time....

Knottyknitter Fri 02-May-14 11:56:46

In a vbac you have a risk the scar on your uterus will rupture. Small chance but its not there without a scar iyswim. Because that is a moment for going straight to section don't pass go, don't collect £200, GA section job, although the risk of it happening are really small, they need to keep an eye on you both.

For the same reason you can't induce in the same way, so more likely to offer elcs if breaking your waters doesn't get things moving as the drip increases the risk too.

Tory79 Fri 02-May-14 12:21:40

Ok, thanks, so there is more monitoring which I'd anticipated - how does this make the labour/birth different to one with less monitoring?

Mummymidwife87 Fri 02-May-14 12:37:31

Your major risk is uterine rupture, 0.05% average. This is when the old cs scar can break down causing major maternal and fetal complications. You are advised to have continuous monitoring of the fetal heart in labour and your labour is generally monitored very closely. Some hospitals still off normal IOL including pessaries, hormone drip etc, others not. You will also be advised to give birth on a labour ward as opposed to birth centre.

A normal vaginal birth with no previous section runs risks of 11% EmCS rate, 10% instrumental rate. You can still have a ruptured uterus without a cS scar, but very very rare, and usually associated with mismanagement of labour. You would have a choice of giving birth on labour ward, birth centre or home, and if low risk would usually have intermittent auscultation for fetal monitoring.

You need to weigh up the pros and cons of vbac vs repeat cs. Both run risks.
Risks to baby: 1-2% suffer lacerations during cs procedure
3-4% experience respiratory distress which may require admission to neonatal unit
Maternal risks: persistent wound and abdominal pain, more likely to here admitted to hospital in the postnatal period, more likely to suffer a major haemorrhage and require a blood transfusion, increased risk of infection, significantly more likely to develop a DVT.

Plus you need to look at how big a family you are planning, multiple Cs increase risks.

Vaginal birth following CS, as already stated uterine rupture 0.05%, vaginal and perineal trauma is common, about 90% of women have some kind of tearing, usually reasonably minor, risk of instrumental birth, about 10%, and obviously emergency CS I always a risk.

Look at your personal circumstances, how old is your other child, caring for a newborn and young child is hard work when you're recovering from a cS.

Hope that's of some help.

Mummymidwife87 Fri 02-May-14 12:39:13

And in answer to you Q re. Monitoring, birth would be the same, but sometimes during labour it can be more difficult to mobilise during labour, but not impossible by any stretch. A significant proportion of women have continuous monitoring and mobilise very well, in all positions and have no issues birthing their baby

Knottyknitter Fri 02-May-14 12:39:21

More likely to be restricted position wise, even though there are mobile monitors they lose reception more often if you move. Less so with a fetal scalp electrode than external monitoring, & if it was me id want to switch to that as soon as practical to get it on.

Not an issue for me yet as only expecting dc1 but used to work in maternity!

Mummymidwife87 Fri 02-May-14 12:40:02

And apologies, I meant 'offer IOL' not 'off' in my original post

riksti Fri 02-May-14 12:44:22

I haven't had a natural birth but did have a VBAC a month ago. It was a lot more monitored. I wasn't left to just get on with it but was said: 'we'll let you go for four hours and then reassess' and 4 hours later half a dozen (I may be exaggerating) doctors came in to discuss further options. So they had specific maximum times they allowed me to labour on my own before they started suggesting further intervention. To be fair - my labour was slow and the help was probably needed smile my friend didn't have any of this with her VBAC since her labour was a lot faster, so it depends on how well you labour overall.

The constant monitoring worried me as well but I hardly even noticed it during labour since it still allowed me to move around the bed, sit on the ball etc.

Tory79 Fri 02-May-14 15:40:03

Thanks everyone.

mummymidwife no plans for a third! mainly as I really don't enjoy being pg! Ds will be just 3. Pil live 5m away from us and are both retired and happy to help with ds so I would have help if I did have another section.

Although I have no horrible labour or birth experience story, I am feeling waaaay more nervous about giving birth this time round than I was with ds.

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